Acute occupational inhalation injuries-United States, 2011-2022.

BACKGROUND: Inhalation injuries due to acute occupational exposures to chemicals are preventable. National surveillance of acute inhalation exposures is limited. This study identified the most common acute inhalation exposure-related incidents by industry sector among US workers. METHODS: To characterize inhalation-related injuries and their exposures during April 2011-March 2022, state and federal records from the Occupational Safety and Health Administration (OSHA) Occupational Safety and Health Information System (OIS) accident database were analyzed. Industry-specific injury, hospitalization, and fatality rates were calculated. RESULTS: The most frequent acute inhalation incidents investigated by OSHA were caused by inorganic gases (52.9%) such as carbon monoxide (CO) or acids, bases, and oxidizing chemical agents (12.9%) such as anhydrous ammonia. The largest number of fatal and nonfatal injuries were reported in the manufacturing (28.6%) and construction (17.2%) sectors. CONCLUSIONS: Workers were affected by acute inhalation exposures in most industries. Using this surveillance, employers can recognize frequently-occurring preventable acute inhalation exposures by industry, such as inorganic gases in the manufacturing sector, and implement prevention measures. Training of workers on exposure characteristics and limits, adverse health effects, and use of protective equipment by exposure agent can prevent inhalation injuries.

Estimation of the number of workers exposed to respirable crystalline silica by industry: Analysis of OSHA compliance data (1979-2015).

BACKGROUND: Respirable crystalline silica (RCS) can potentially cause silicosis, lung cancer, and renal failure. The current study estimates the percentages of workers potentially overexposed to concentrations of RCS dust and silicosis proportional mortality rates (PMRs) by industry. METHODS: Occupational Safety and Health Administration compliance inspection sampling data for RCS collected during 1979 to 2015 were used to estimate percentages of workers exposed. The results were used in combination with US Census Bureau estimates to produce industry specific worker population estimates for 2014. Estimates of the numbers and percentages of workers exposed to RCS concentrations at least 1, 2, 5, and 10 times the National Institute for Occupational Safety and Health recommended exposure limit (REL) were calculated by industry using the 2002 North American Industry Classification System. Silicosis PMRs by industry were estimated using National Center for Health Statistics multiple cause of death data. RESULTS: RCS concentrations/workers exposed were highest in the poured concrete foundation and structure contractors; commercial and institutional building construction; and masonry contractors. Approximately 100 000 workers were exposed above the RCS REL, and most (79%) worked in the construction industry. Tile and terrazzo contractors (12%); brick, stone, and related construction merchant wholesalers (10%); masonry contractors (6%) and poured concrete foundation and structure contractors (6%) were the highest percentages of workers potentially overexposed. PMRs were highest for the structural clay product manufacturing and the foundries industries. CONCLUSION: Percentages of workers exposed to RCS varied by industry and in some industries workers are exposed over 10 times the REL. Exposures can be reduced below the REL by implementing the hierarchy of controls.

Respirable coal mine dust at surface mines, United States, 1982-2017.

BACKGROUND: Exposure to respirable coal mine dust can cause pneumoconiosis, an irreversible lung disease that can be debilitating. The mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by occupation, by geographic region) from surface coal mines and surface facilities at U.S. underground mines during 1982-2017 were summarized. METHODS: Mine Safety and Health Administration (MSHA) collected and analyzed data for respirable dust and a subset of the samples were analyzed for quartz content. We calculated the respirable dust and quartz concentration geometric mean, arithmetic mean, and percent of samples exceeding the respirable dust permissible exposure limit (PEL) of 2.0 mg/m3, and the average percent of quartz content in samples. RESULTS: The geometric mean for 288 705 respirable dust samples was 0.17 mg/m3 with 1.6% of the samples exceeding the 2.0 mg/m3 PEL. Occupation-specific geometric means for respirable dust in active mining areas were highest among drillers. The geometric mean for respirable dust was higher in central Appalachia compared to the rest of the U.S. The geometric mean for respirable quartz including 54 040 samples was 0.02 mg/m3 with 15.3% of these samples exceeding the applicable standard (PEL or reduced PEL). Occupation-specific geometric means for respirable quartz were highest among drillers. CONCLUSION: Higher concentrations of respirable dust or quartz in specific coal mining occupations, notably drilling occupations, and in certain U.S. regions, underscores the need for continued surveillance to identify workers at higher risk for pneumoconiosis.

Occupational exposure and airflow obstruction and self-reported COPD among ever-employed US adults using a COPD-job exposure matrix.

INTRODUCTION: This study examined the association of spirometry-defined airflow obstruction and self-reported COPD defined as self-reported doctor diagnosed chronic bronchitis or emphysema, with occupational exposure among ever-employed US adults. METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian US population. Reported current and/or longest held job were used to create prevalence estimates and prevalence odds ratios (PORs) (adjusted for age, gender, race, and smoking status) for airflow obstruction and self-reported COPD by occupational exposure, determined using both NHANES participants' self-reported exposures and eight categories of COPD job exposure matrix (JEM) assigned exposures. RESULTS: Significant PORs for airflow obstruction and self-reported COPD respectively were observed with self-reported exposure for ≥20 years to mineral dust (POR = 1.44; 95% confidence interval (CI) 1.13-1.85; POR = 1.69; 95% CI 1.17-2.43) and exhaust fumes (POR = 1.65; 95% CI 1.27-2.15; POR = 2.22; 95% CI 1.37-3.58). Airflow obstruction or self-reported COPD were also associated with COPD-JEM assigned high exposure to mineral dust, combined dust, diesel exhaust, vapor-gas, sensitizers, and overall exposure. CONCLUSION: Airflow obstruction and self-reported COPD are associated with both self-reported and JEM-assigned exposures.

Airflow obstruction among ever-employed U.S. adults aged 18-79 years by industry and occupation: NHANES 2007-2008 to 2011-2012.

INTRODUCTION: This study estimated the prevalence of spirometry-defined airflow obstruction by industry and occupation and chronic obstructive pulmonary disease (COPD) among ever-employed U.S. adults. METHODS: Data came from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian U.S. POPULATION: Data on respondent's current and/or longest held job were used to create prevalence estimates and adjusted prevalence odds ratios (PORs) for airflow obstruction and COPD. RESULTS: Among ever-employed U.S. adults, airflow obstruction prevalence was 12.40% and COPD was 3.47%. High airflow obstruction prevalence and significant PORs were reported in mining; manufacturing; construction; and services to buildings industries as well as extraction; bookbinders, prepress, and printing; installers and repairers; and construction occupations. CONCLUSION: Prevalence of airflow obstruction varies by industry and occupation. Industries and occupations with increased risk were identified using the most current NHANES data including detailed occupations and spirometry.

Respirable coal mine dust in underground mines, United States, 1982-2017.

BACKGROUND: This study summarized the mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by district, and by occupation) from underground coal mines during 1982-2017. METHODS: Respirable dust and quartz data collected and analyzed by Mine Safety and Health Administration (MSHA) were summarized by year, coal mining occupation, and geographical area. The older (before August 2016) 2.0 mg/m 3 respirable dust MSHA permissible exposure limit (PEL) was used across all years for comparative purposes. For respirable dust and quartz, geometric mean and percent of samples exceeding the respirable dust PEL (2.0 mg/m 3 or a reduced standard for samples with >5% quartz content) were calculated. For quartz samples, the average percent quartz content was also calculated. RESULTS: The overall geometric mean concentration for 681 497 respirable dust samples was 0.55 mg/m 3 and 5.5% of the samples exceeded the 2.0 mg/m 3 PEL. The overall respirable quartz geometric mean concentration for 210 944 samples was 0.038 mg/m 3 and 18.7% of these samples exceeded the applicable standard. There was a decline over time in the percent of respirable dust samples exceeding 2.0 mg/m 3 . The respirable dust geometric mean concentration was lower in central Appalachia compared to the rest of the United States. However, the respirable quartz geometric mean concentration and the mean percent quartz content were higher in central Appalachia. CONCLUSION: This study summarizes respirable dust and quartz concentrations from coal mine inspector samples and may provide an insight into differences in the prevalence of pneumoconiosis by region and occupation.

Interprofessional reconstruction of a policy for academic advancement: The evolution and evaluation of scholarship for today, tomorrow, and beyond.

Within higher education, scholarship is narrowly and inconsistently defined, limiting recognition of evolving faculty expectations, particularly for nursing faculty. At this academic medical center, a campus-wide, multi-school, academic advancement policy was achieved with a broader definition of scholarship that included: peer-reviewed publication of federally funded research, as well as innovation in curriculum development, teaching methodology, community engagement, safety and quality improvement, clinical practice, and health policy that would be applicable to tenure and non-tenure track faculty. The background, process, and outcomes of developing an expanded definition of scholarship that encompasses new and evolving areas of scholarship for a reconstructed academic personnel policy is presented. Beginning with a literature review and surveys of other schools' policies, we describe how a campus-wide working group ensured consensus and acceptance of the new policy. Upon approval of the reconstructed document, guidelines for implementation were widely disseminated through training workshops and discussions, integration into new faculty orientation, and faculty development programs. We share our process, outcomes, and lessons learned believing this information to be useful to other institutions engaged in review and revision of their promotion and tenure processes to align with the increasing expectations of nursing faculty of today and tomorrow.

Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program.

Objectives: To describe the development and refinement of an implicit bias recognition and management training program for clinical trainees. Methods: In the context of an NIH-funded clinical trial to address healthcare disparities in hypertension management, research and education faculty at an academic medical center used a participatory action research approach to engage local community members to develop and refine a "knowledge, awareness, and skill-building" bias recognition and mitigation program. The program targeted medical residents and Doctor of Nursing Practice students. The content of the two-session training included: didactics about healthcare disparities, racism and implicit bias; implicit association test (IAT) administration to raise awareness of personal implicit bias; skill building for bias-mitigating communication; and case scenarios for skill practice in simulation-based encounters with standardized patients (SPs) from the local community. Results: The initial trial year enrolled n = 65 interprofessional participants. Community partners and SPs who engaged throughout the design and implementation process reported overall positive experiences, but SPs expressed need for greater faculty support during in-person debriefings following simulation encounters to balance power dynamics. Initial year trainee participants reported discomfort with intensive sequencing of in-person didactics, IATs, and SP simulations in each of the two training sessions. In response, authors refined the training program to separate didactic sessions from IAT administration and SP simulations, and to increase safe space, and trainee and SP empowerment. The final program includes more interactive discussions focused on identity, race and ethnicity, and strategies to address local health system challenges related to structural racism. Conclusion: It is possible to develop and implement a bias awareness and mitigation skills training program that uses simulation-based learning with SPs, and to engage with local community members to tailor the content to address the experience of local patient populations. Further research is needed to measure the success and impact of replicating this approach elsewhere.

Potential determinants of coal workers' pneumoconiosis, advanced pneumoconiosis, and progressive massive fibrosis among underground coal miners in the United States, 2005-2009.

OBJECTIVES: We better defined the distribution and determinants of coal workers' pneumoconiosis (CWP) among US underground coal miners. METHODS: We obtained chest radiographs from the mobile unit of an enhanced surveillance program begun in 2005 by the National Institute for Occupational Safety and Health for underground coal miners. B Readers classified them for presence of pneumoconiosis. RESULTS: Miners from 15 states participated (n = 6658). The prevalence of CWP was higher in 3 states (Kentucky, 9.0%; Virginia, 8.0%; West Virginia, 4.8%) than in 12 other states (age-adjusted risk ratio [RR] = 4.5; 95% confidence interval [CI] = 3.3, 6.1). Miners in these 3 states were younger and had less mining tenure, but advanced CWP (category ≥ 2/1; RR = 8.1; 95% CI = 3.9, 16.9) and progressive massive fibrosis (RR = 10.5; 95% CI = 3.8, 29.1) was more prevalent among them. Advanced CWP and progressive massive fibrosis were more prevalent among workers at mines with fewer than 155 miners, irrespective of mining region, than among workers at larger mines. CONCLUSIONS: Enhanced surveillance results confirmed the persistence of severe CWP among US coal miners and documented the health consequences of inadequate dust control for miners in parts of Appalachia and at smaller mines.

COVID-19 Test Us: A Case for Embedding Ethics and Regulatory Expertise.

A key aspect of the National Institutes of Health (NIH) funded Rapid Acceleration of Diagnostics (RADx) Tech program was an active Clinical Studies Core including Committees with unique expertise to facilitate the development and implementation of studies to test novel diagnostic devices for Covid-19. The Ethics and Human Subjects Oversight Team (EHSO) was tasked to provide ethics and regulatory expertise to stakeholders in the RADx Tech effort. The EHSO developed a set of Ethical Principles to guide the overall effort and provided consultation on a wide range of ethical and regulatory concerns. Having access to a pool of experts with ethical and regulatory knowledge who met weekly to tackle issues of importance to the investigators was critical to the overall success of the project.

Coal workers' pneumoconiosis in the United States: regional differences 40 years after implementation of the 1969 Federal Coal Mine Health and Safety Act.

OBJECTIVE: To assess whether the recent increases in the prevalence of coal workers' pneumoconiosis (CWP) in the USA reflect increased measured exposures over recent decades, and to identify other potential causative factors. METHODS: The observed CWP prevalence was calculated for 12,408 underground coal miner participants in the Coal Workers' Health Surveillance Program for the period 2005-2009, stratified by the Mine Safety and Health Administration (MSHA) geographical districts. The predicted prevalence was estimated using a published exposure-response model from a large epidemiological study among U.S. coal miners using dust exposure, tenure, miner's age and coal rank as predictors. χ2 Testing was performed to compare the observed versus predicted CWP prevalence. RESULTS: Observed prevalence was significantly higher than predicted prevalence in MSHA districts 4-7 (central Appalachian region) (10.1% vs. 4.2%; prevalence ratio (PR) 2.4; p<0.001) and significantly lower than predicted in other regions (1.6% vs. 3.6%; PR 0.4; p<0.001). The central Appalachian region had a significantly older workforce with greater mining tenure, a lower proportion of mines with 200 or more employees, and lower seam heights. Significant lower average compliance dust concentrations were reported for this region. CONCLUSION: The observed CWP prevalence substantially exceeded predicted levels in central Appalachia. However, the increased prevalence was not explained by the measured levels of dust exposures. Likely contributing factors include mine size and low seam mining, which may be associated with higher exposure to silica. Further study is needed to characterise the responsible factors for the elevated CWP rates in central Appalachia.

Integration of basic clinical skills training in medical education: an interprofessional simulated teaching experience.

BACKGROUND: A 2004 survey reveals that the implementation of the 1998 AAMC report on medical student clinical skills training is slow. Given the importance of intravenous catheter placement, a creative approach evolved to educate medical students on this important skill. DESCRIPTION: As part of a community service learning initiative, six graduate nursing students developed, implemented, and evaluated a pilot IV Cannulation Education Module taught to medical students. EVALUATION: Data analysis of 63 participants reveals improved knowledge and confidence in medical students' ability to place an intravenous catheter. The objectives were met and the process enjoyed by students of both professions. CONCLUSION: Opportunities for interprofessional teaching and learning include clinical skills training. Medical students learned an important skill taught by graduate nursing students who developed and evaluated a curriculum that met their own graduate course objectives. Both professions appreciated the opportunity to work collaboratively to achieve their respective programmatic goals.

COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP): A study protocol.

BACKGROUND: Healthcare professionals have negative implicit biases toward minority and poor patients. Few communication skills interventions target implicit bias as a factor contributing to disparities in health outcomes. We report the protocol from the COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a trial evaluating a novel educational and training intervention targeting graduate medical and nursing trainees that is designed to mitigate the effects of implicit bias in clinical encounters. The CONSULT-BP intervention combines knowledge acquisition, bias awareness, and practice of bias mitigating skills in simulation-based communication encounters with racially/ethnically diverse standardized patients. The trial evaluates the effect of this 3-part program on patient BP outcomes, self-reported patient medication adherence, patient-reported quality of provider communication, and trainee bias awareness. METHODS: We are conducting a cluster randomized trial of the intervention among cohorts of internal medicine (IM), family medicine (FM), and nurse practitioner (NP) trainees at a single academic medical center. We are enrolling entire specialty cohorts of IM, FM, and NP trainees over a 3-year period, with each academic year constituting an intervention cycle. There are 3 cycles of implementation corresponding to 3 sequential academic years. Within each academic year, we randomize training times to 1 of 5 start dates using a stepped wedge design. The stepped wedge design compares outcomes within training clusters before and after the intervention, as well as across exposed and unexposed clusters. Primary outcome of blood pressure control is measured at the patient-level for patients clustered within trainees. Eligible patients for outcomes analysis are: English-speaking; non-White racial/ethnic minority; Medicaid recipient (regardless of race/ethnicity); hypertension; not have pregnancy, dementia, schizophrenia, bipolar illness, or other serious comorbidities that would interfere with hypertension self-control; not enrolled in hospice. Secondary outcomes include trainee bias awareness. A unique feature of this trial is the engagement of academic and community stakeholders to design, pilot test and implement a training program addressing healthcare. DISCUSSION: Equipping clinicians with skills to mitigate implicit bias in clinical encounters is crucial to addressing persistent disparities in healthcare outcomes. Our novel, integrated approach may improve patient outcomes. TRIAL REGISTRATION: NCT03375918. PROTOCOL VERSION: 1.0 (November 10, 2020).

Correctional health curriculum enhancement through focus groups.

BACKGROUND: Little has been published describing curricular experiences in correctional health (CH). PURPOSES: Our goal is to articulate a curriculum cognizant of the special needs of the correctional health care worker. METHODS: We conducted focus groups with nurses, nurse practitioners, physician assistants, and physicians focused on content crucial to prepare competent medical professionals committed to careers in correctional health. RESULTS: Six main themes emerged from the data, which were used to confirm and add to the growing curriculum on correctional health used in our university's correctional health electives. The themes are (a) characteristics of the population being served; (b) prevalent conditions requiring clinical expertise; (c) public health opportunities in correctional facilities; (d) ethical considerations; (e) medical-legal issues; and (d) the CH system, structure, and administration. CONCLUSIONS: The successful provision of health care in correctional settings requires specialized knowledge, skills, and awareness not typically available in other health care training settings.

Lifestyle behaviours and weight among hospital-based nurses.

AIMS: The purpose of this study was to (i) describe the weight, weight-related perceptions and lifestyle behaviours of hospital-based nurses, and (ii) explore the relationship of demographic, health, weight and job characteristics with lifestyle behaviours. BACKGROUND: The obesity epidemic is widely documented. Worksite initiatives have been advocated. Nurses represent an important part of the hospital workforce and serve as role models when caring for patients. METHODS: A sample of 194 nurses from six hospitals participated in anthropometric measurements and self-administered surveys. RESULTS: The majority of nurses were overweight and obese, and some were not actively involved in weight management behaviours. Self-reported health, diet and physical activity behaviours were low, although variable by gender, age and shift. Reports of co-worker norms supported low levels of healthy behaviours. CONCLUSIONS: Findings reinforce the need to address the hospital environment and culture as well as individual behaviours for obesity control. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers have an opportunity to consider interventions that promote a climate favourable to improved health habits by facilitating and supporting healthy lifestyle choices (nutrition and physical activity) and environmental changes. Such efforts have the potential to increase productivity and morale and decrease work-related disabilities and improve quality of life.

The National Institute for Occupational Safety and Health B Reader Certification Program-An Update Report (1987 to 2018) and Future Directions.

OBJECTIVE: The National Institute for Occupational Safety and Health (NIOSH) B Reader Program provides the opportunity for physicians to demonstrate proficiency in the International Labour Office (ILO) system for classifying radiographs of pneumoconioses. We summarize trends in participation and examinee attributes and performance during 1987 to 2018. METHODS: Since 1987, NIOSH has maintained details of examinees and examinations. Attributes of examinees and their examination performance were summarized. Simple linear regression was used in trend analysis of passing rates over time. RESULTS: The mean passing rate for certification and recertification for the study period was 40.4% and 82.6%, respectively. Since the mid-1990s, the number of B Readers has declined and the mean age and years certified have increased. CONCLUSIONS: To address the declining B Reader population, NIOSH is currently taking steps to modernize the program and offer more opportunities for training and testing.

Managing a disaster scene and multiple casualties before help arrives.

As the largest group of health care professionals in the United States and a component of almost every community, nurses may be called upon to initiate the emergency response and provide initial planning for health care until local, national, or federal assistance arrives. This article will assist nurses in anticipating, preparing for, and responding to multi-casualty, high-impact events. It concludes with a discussion of triage of multi-casualties in the face of scarce resources. It includes resources for more in-depth information on prevention, preparedness and planning, and the health system's response.

The impact of deliberate reflection with WISE-MD™ modules on surgical clerkship students' critical thinking: a prospective, randomized controlled pilot study.

PURPOSE: Critical thinking underlies several Association of American Medical Colleges (AAMC)-defined core entrustable professional activities (EPAs). Critical-thinking ability affects health care quality and safety. Tested tools to teach, assess, improve, and nurture good critical-thinking skills are needed. This prospective randomized controlled pilot study evaluated the addition of deliberate reflection (DR), guidance with Web Initiative in Surgical Education (WISE-MD™) modules, to promote surgical clerks' critical-thinking ability. The goal was to promote the application of reflective awareness principles to enhance learning outcomes and critical thinking about the module content. PARTICIPANTS AND METHODS: Surgical clerkship (SC) students were recruited from two different blocks and randomly assigned to a control or intervention group. The intervention group was asked to record responses using a DR guide as they viewed two selected WISE-MD™ modules while the control group was asked to view two modules recording free thought. We hypothesized that the intervention group would show a significantly greater pre- to postintervention increase in critical-thinking ability than students in the control group. RESULTS: Neither group showed a difference in pre- and posttest free-thought critical-thinking outcomes; however, the intervention group verbalized more thoughtful clinical reasoning during the intervention. CONCLUSION: Despite an unsupported hypothesis, this study provides a forum for discussion in medical education. It took a sponsored tool in surgical education (WISE-MD™) and posed the toughest evaluation criteria of an educational intervention; does it affect the way we think? and not just what we learn, but how we learn it? The answer is significant and will require more resources before we arrive at a definitive answer.

Radiographic features of importance in the National Institute for Occupational Safety and Health-administered Coal Workers' Health Surveillance Program: characterising the use of the 'other symbols'.

OBJECTIVE: The National Institute for Occupation Safety and Health-administered Coal Workers' Health Surveillance Program (CWHSP) provides radiographic pneumoconiosis screening for US coal miners. Radiographs are classified by readers according to International Labour Office criteria. In addition to pneumoconiotic parenchymal and pleural lung abnormalities, readers document radiographic features of importance (other symbols). Other symbols are not meant to imply a diagnosis or interpretation but are relevant as they provide information beyond a pneumoconiosis classification for features related to dust exposure and other aetiologies. Our objective was to summarise other symbol data from 48 years of CWHSP participants. METHODS: Chest radiograph classifications obtained from CWHSP participants between July 1968 and July 2016 were analysed. Any 'other symbol' indication from any of the readings were counted. Frequencies were tabulated by individual reader and those identified by any reader. RESULTS: Of the 469 922 radiographs included in this study, nearly 15% had at least one reader identify a radiographic feature of importance. The most commonly identified other symbol was cancer (excluding mesothelioma) (6.83%), followed by emphysema (1.68%). Some features were rarely identified over the 48 years of data collection such as rheumatoid pneumoconiosis (n=46), pneumothorax (n=32), mesothelioma (n=12) and rounded atelectasis (n=4). CONCLUSIONS: This is the largest study to date describing radiographic features of importance as part of routine chest radiographic surveillance. While these symbols are not diagnostic they can be used to describe features associated with dust exposure. One of the most commonly identified radiographic features in our population is emphysema which is associated with respirable dust exposure. These results can be compared with other dust exposed populations.